American College of Radiology blog

Is Radiology Recession-Proof?

As more Americans are feeling the effects of the economy, it should come as no surprise that people are opting out of health care. The primary reason? Costs.

A survey of 12,000 Americans released last week found that about 20 percent of Americans have skipped medical care. About the same percentage thought they would have a difficult time paying for medical care in the future. However, only about 8 percent of those surveyed indicated skipping some form of medical imaging. More than half said they skipped a doctor’s visit.

Does that mean that Americans value medical imaging over a visit to their primary care doctor? That would be hard to determine from this one study. But it is something to think about.

The College is interested in knowing what you think.

• Has your practice or hospital experienced any effects from the economy?

• Or, have patients cancelled any imaging studies due to costs?

I look forward to hearing your thoughts.

ACR, Patient Groups, Industry Make Case for CTC Coverage

Despite significant evidence of CT colonography’s effectiveness as a screening tool for colorectal cancer, on Feb. 11, the Centers for Medicare and Medicaid Services (CMS) announced a proposed decision not to cover the exam, stating that the evidence was inadequate to conclude that CTC would provide health benefits to the average Medicare beneficiary.

In the CMS proposed decision memo, opponents to coverage cited unknown effects from radiation exposure associated with the exam, questions as to the amount of training necessary to properly read the exam, and concern that it would be difficult to generalize the results of the ACRIN CT Colonography Trial to the average practice setting and specifically to the Medicare population.

The ACR and other societies have been working together to reverse CMS’s proposal by educating members of Congress that using CTC as a screening method for colorectal cancer will help more people to get screened, aid in early detection and ultimately help save lives.

At a Capitol Hill briefing last Monday, Elizabeth McFarland, M.D., chair of the ACR Colon Cancer Committee, made a presentation to congressional and regulatory staff members on behalf of the College as to the effectiveness and importance of this exam. In response to these efforts, several lawmakers have signed on to letters written to CMS urging them to cover CTC.

In a letter to the editor published in Saturday’s New York Times, Andrew R. Spiegel, chief executive of the Colon Cancer Alliance, Ilyse Schuman, managing director of the Medical Imaging and Technology Alliance, and myself, reinforced the proven cost-effectiveness of CTC as well as its “potential to enhance colon cancer screening compliance.”

The 30-day public comment period for the proposal ended on Friday, CMS is expected to make a final (at least for the immediate future) decision on coverage by May 12.

For those of you who currently offer/perform CTC:

• Has your practice seen an increase in CTC volume since the results of the ACRIN study were published in the New England Journal of Medicine last fall or a decrease since CMS proposed not to cover the exam?

And if you do not currently offer/perform CTC:

• Will Medicare’s final coverage decision determine whether or not you add this exam to your practice or seek out training?
  
  

I look forward to your thoughts.

Radiation Exposure Back in the News

As you may know, on Tuesday, the National Council for Radiation Protection and Measurement (NCRP) issued a report stating that Americans were exposed to seven times more radiation from medical imaging exams in 2006 than they were in 1980.

Radiation exposure is always a hot topic and has garnered a significant amount of media attention over the past several years. Some of this attention can alarm patients, as did the November 2007 NEJM study which claimed that up to 2 percent of all cancers can be attributed to radiation received from CT scans.

The College immediately issued a response to the latest NCRP report advising patients to consider the information within the report in its proper context and to discuss any concerns about radiation exposure with their doctor. It is important for people to understand the undeniable benefits of medical imaging in early detection and staging of diseases, and not to forgo testing out of fear.

Although the NCRP report did not go into causes of the dramatic increase in dose, the NCRP’s executive director did, at a recent international conference, identify self-referral as a primary driver of the trend.

The ACR response and statements by College spokespersons made clear the tie between self-referral and increased imaging in a resulting Reuters Health article and in other print and broadcast news reports.

The NCRP study also served as an opportunity for the to College to publicize what steps have been done thus far to lower dose, like the adoption of principles such as ALARA (as low as reasonably achievable), the Image Gently^SM campaign (www.imagegently.org), and ACR Appropriateness Criteria® (www.acr.org/ac) which can help physicians prescribe the most appropriate imaging exam for more than 200 clinical conditions.

I would like to know:

• What are your overall thoughts on this NCRP report?

• Have you had patients ask you about radiation risk as a result of the report and the associated media coverage?

• What do you tell them?

*Note: Keep in mind your comments will be in the public domain.

Savings Through Spending: Obama’s Budget Announced

On Thursday, President Obama announced his $3.6 trillion budget plan for the 2010 fiscal year. The plan would create a “health care reserve” costing $634 billion over 10 years, in an effort to provide universal health coverage. Tax increases and cuts to Medicare and Medicaid would fund the reserve.

According to the plan, increased spending on insuring all Americans upfront will save money in the long run, because patients will seek out care and engage in preventative measures to reduce the occurrence of chronic (and often costly) diseases.

The proposed plan would seek to control imaging costs through the use of radiology benefit management companies in the Medicare program. The ACR, however, has argued that the use of Appropriateness Criteria in an order entry system is a better way to monitor imaging, and ensures that patients receive the best study for their condition in a timely manner.

Other health care measures in the plan include:

• $1 billion to the FDA to improve food safety
• $6 billion for cancer research
• $76.8 billion toward EMR adoption and medical treatment comparison
• $330 million toward addressing doctor and nurse shortages

What do you think about the budget plan in terms of health care reform?

What do you think are the strengths and shortcomings of the plan?

I look forward to your comments.

Good, Better and Best Practices

My column in this month’s ACR Bulletin focuses on how collaborating with others on best practices can lead to quality improvement and overall patient satisfaction. Focusing on improvement doesn’t necessarily mean that your practice is sub-par or not meeting certain standards of care; it simply means that we as physicians recognize that in this ever-changing health care arena, there are bound to be new ideas or solutions for things we do every day.

This being said, I’d like to hear what best practices you’ve adopted and made part of your daily routine. How did you identify the need for a change? What has worked and what hasn’t? Perhaps it was as simple as providing patients with educational materials before an exam. Or, maybe you invested in new imaging equipment, or learned a cutting-edge technique. Feel free to leave details in the comments section to share with other members.

I’m looking forward to your responses. And, be sure to read the articles in this month’s Bulletin for more ideas, tips, and testimonials from your colleagues on implementing best practices.

Image Gently Campaign Reaches Out to Parents

In January 2008, the Alliance for Radiation Safety in Pediatric Imaging launched the Image Gently campaign, to bring attention to the opportunities for medical imaging professionals to lower or optimize the radiation dose when performing imaging studies on children.

This month, the campaign is introducing new materials to educate parents about medical imaging.

The first item is an imaging record card — parents are encouraged to use this record as they do the widely-used vaccination record. It will allow parents to keep track of pertinent information related to their child’s exams — where and when the study was performed as well as the type of exam. Tracking the number of radiologic studies children have received helps inform treating physicians of recent similar exams, helping to decide if an exam is truly necessary.

Also created were two pamphlets which explain the various imaging exams with a focus on CT scans and radiation safety. Potential risks involved with imaging are discussed as well as estimated effective doses. These tools are available now to download from the Image Gently Web site (www.imagegently.org).

We encourage you to make these available in your patient waiting areas and offices, and inform the parents of your pediatric patients that these resources have been created for them.

Additionally, information brochures are now also available on the American Academy of Pediatrics Web site for parents and pediatricians.

If you haven’t done so already, please take the Image Gently pledge to show your commitment to “child-sizing” the radiation dose used in children’s imaging.

I would also be interested in knowing:

• Do you typically get questions from parents regarding radiation dose used in pediatric imaging?

• Do you think these materials will help you answer them?

• What do you typically say to patients with questions regarding dose?
  
  

I look forward to your feedback.

How We’ll Tackle 2009

Get organized …
Lend a hand …
Listen more …

These may seem like your basic list of New Year’s resolutions, but they’re actually taken straight from our colleagues in the field.

In the latest edition of ADVANCE for Imaging and Radiation Therapy Professionals, I offered my vision for what the ACR would put forward in 2009. You can read what I (and others) had to say here.

It’s no secret that we will face another round of hard issues in the year ahead. With the Obama Administration taking office in just a few days, there are already items on the table that will affect us. Prior authorization is one of them; changes to how Medicare reimburses for the technical component of imaging exams is another.

Education and advocacy remain at the heart of the College’s mission, and we will continue to strengthen our presence in the face of the forthcoming health care legislation.

There are a great many items on the agenda for 2009. New courses will be added to the ACR Education Center over the next few months. ACR staff is working to tailor your membership to your needs, using the newly launched Practice of Radiology Environment Database (PRED), and much more.

Despite any challenges we encounter this year (and there will be challenges), the ACR will remain at the forefront to lead the way. Please write in with what you think radiology’s biggest challenges are for the coming year and how you think the ACR can help.

I very much look forward to your input.

Unnecessary Invasive Breast Biopsies

In case you missed it, CBS News recently aired a story regarding a study which showed that approximately 600,000 women each year receive invasive breast biopsies performed by surgeons when referring them to a radiologist for a needle/stereotactic biopsy would be just as effective at confirming or ruling out cancer, would be less costly, less invasive, and would leave the patient with a far smaller scar.

If you are having trouble viewing the video below, it can also be viewed on the CBS Web site (a short commercial will air before the segment begins).

I am not a breast imager by subspecialty, but would be interested to know whether this is a pattern of referral behavior that you are seeing in your market (without mentioning specific names).

If so — what do you think radiologists can and/or should do to counter this trend?

What would you recommend that patients ask their referring physicians regarding this process?

I look forward to hearing from you.

Increased CT Ownership in Nonradiologists

An interesting trend was examined in the December issue of JACR — CT ownership in nonradiologist specialties.

When we hear about anything related to equipment ownership, imaging growth, or self-referral, primary care is typically not top of mind. But according to the study authors from Thomas Jefferson University, the nonradiologist specialty with the highest growth in CT procedures in 2006 was, in fact, primary care. Moreover, nonradiologist ownership of CT increased by 263 percent from 2001-2006.

There are of course many implications for radiologists. For one, market share — and the rapid pace at which nonradiologists are gaining it. Also, rising opportunities for self-referral, radiation safety concerns, and costs to the health care system.

The full article which appears in the December issue of JACR can be read online by clicking here and downloading the PDF.

What are your thoughts about this study and the results? What ownership/leasing arrangements have you seen that support these findings? I look forward to your comments.

Side Note 1: The JACR Editorial Board is excited about a new member benefit coming to the journal. Look for the CME icon next to the JACR cover on the ACR Web site starting with the January 2009 issue and claim CME for reading JACR. The Web site www.jacr.org is also going through a redesign so be sure to visit the site in January to see what’s new.

Side Note 2: There is a link on the left-hand side of this page to “Contact a Blog Contributor.” We want to talk about issues you are facing, so please don’t hesitate to contact us about topics of importance to you. We are also looking for some guest bloggers to weigh in every now and then; so let us know if you’re interested and we’ll talk. Thanks for reading.

How Will the ABR’s Changes to Diagnostic Radiology Boards’ Structure and Timing Affect You?

We are all well aware that the American Board of Radiology (ABR) has planned changes to future certification exams in radiology. This will affect residents beginning in 2010, and will not alter the training of those already in residency. The last time this topic was discussed on the blog, many of you voiced your concerns over the decision to delay the certifying exam to 15 months out of residency, and how the changes may create too strong an emphasis on subspecialization.

These changes have been in deliberation for years — those who agree with the changes believe fourth-year residents should concentrate on their responsibilities, and not have to balance studying at the same time; those on the other side believe that residents in their fourth year are best suited to handle the core competency-based format and therefore the exam should remain static.

In response to the many questions ACR members had regarding these changes — rather than deliberate the pros and cons to each side of the debate — the College created a task force to consider the potential impact of changes in the diagnostic radiology boards’ structure and timing. I served as chair, and my fellow members included a mix resident physicians, and private and academic practice members.

So, what will these changes mean for those of us at present — those already in practice?

We realized that there would be no easy solution to this question, and we immediately determined a need to create two subcommittees — one to examine the impact of the ABR’s decision on the future practice of radiology and the ACR, and the other to focus on how the change might affect residency training programs and trainees. Our discussions are summarized at length in a white paper in the November issue of the Journal of the American College of Radiology (JACR). To read the paper in its entirety, login to the ACR Web site and then click on the JACR links on the bottom left-hand side of the page.

Was the task force successful at addressing your questions and concerns about this major change in radiology?

How do you think the number of individuals choosing to complete fellowships immediately after residency will change?

And, what other issues, if any, do you foresee?

I look forward to your thoughts.

Scanning for Truth: New Opportunities for fMRI

Recently, the ACR Daily News Scan ran an original article about using MRI as a tool for truth detection.

We are accustomed to using MRI as a screening tool for diagnosing and treating disease — serving as the next-generation polygraph seems a bit far fetched. Or is it?

fMRI truth-testing analyzes blood flow and oxygen changes in the brain, whereas the polygraph focuses on the human stress-response. And, the polygraph is arguably only about 65 percent accurate. One San Diego, Calif.-based firm is currently conducting a large trial set for completion next year, which hopes to achieve upwards of 90 percent accuracy in determining who is telling the truth.

The ACR has not taken a formal position on fMRI for truth detection, nor whether it represents an appropriate use of a diagnostic study for medical-legal purposes. I urge you to read the article in its entirety, as it discusses the medical and legal implications, as well as the opportunities for fMRI use in pre-employment screenings and the criminal justice system.

How do you feel about MRI being used as truth screenings?

Do you think this technology could have real implications on our judicial system?

I look forward to your thoughts.

The Face of Radiology Is Coming to You

The 2008 ACR Annual Report is now in the mail and should arrive to your mailbox shortly (if it has not already). In addition to a wrap-up of the ACR’s achievements over the past year, inside you will find the “Face of Radiology” branding campaign materials we have been talking about and you have been requesting for the past several months: a patient education DVD that also includes the radio advertisement used in test campaign as well as a sample My Radiologist patient education brochure. Also, you can use the enclosed reply card to order free campaign posters (“The Brain”) for your waiting area.

I also wanted to remind you about the Web site we created to help radiologists batter communicate with patients — www.MyPatientConnection.com — which brings together all of these great materials (and more) in one spot. Scroll to the bottom left-hand “Resources” section of the site to view and download the items we have prepared for you to use in promoting the profession to your patients. These resources include a PowerPoint presentation, print advertisements, brochures in both English and Spanish, tips for talking with the media, and more.

We strongly urge you to speak with just five patients per day. It’s the best way to let people know who radiologists are, what radiologists do, and why their education and training are critical elements in patient care.

We also encourage you to use these materials to reach out to your own communities and submit your patient success stories on www.MyPatientConnection.com and let us know what you’re doing to connect with your patients.

If you have any questions, please feel free to contact the ACR’s Public Relations Manager, Shawn Farley, at 703-648-8936 or sfarley@acr.org.

In the meantime, please let me know what you think about the campaign materials and how you think we as radiologists can better reach out to our patients and our communities.

ACRIN CT Colonography Results Published in NEJM

It has been a while since we last talked about CT Colonography. The results of the American College of Radiology Imaging Network’s (ACRIN) CT Colonography trial — which determined that virtual colonoscopy is comparable to standard colonoscopy in its ability to accurately detect polyps — were published in the Sept. 18 issue of the New England Journal of Medicine.

ACR member, C. Daniel Johnson, M.D., of the Mayo Clinic in Scottsdale, Ariz., was the study’s principal investigator. We expect the results of this trial to make a large impact on the number of patients being screened for colon cancer, increase early detection, and ultimately help save lives.

The preliminary results of this large, multi-center trial were presented at the ACRIN annual meeting last fall. Milestones since the initial presentation have been the adoption of CTC as a recommended screening tool by the ACR, the American Cancer Society, and the U.S. Multi-Society Task Force on Colorectal Cancer, and the initiation of a national coverage analysis (NCA) for the use of screening CT Colonography for colorectal cancer issued by CMS.

Below is a video summarizing the ACRIN CT Colonography trial results. Click on the arrow for the video to begin playing.

It is widely known that screening rates for colorectal cancer are low. How do you think the results of the ACRIN trial will impact you and your practice in terms of screening rates, reimbursement for the exam, and the need to undergo any further educational training?

I look forward to your thoughts.

Would You Let a Ghost Do Your Reporting?

The College recently posted to the Web site an original article, Ghost Reporting: The “Scary” Specter of Rubber-Stamped Reads. The article focused on what ghost reporting is — the practice of a U.S. radiologist signing off on a report that was actually done by someone else — and what can be done to stop it.

I think ghost reporting is unethical as well as a gross disservice to patients. The ghost reader might be a radiologist or another doctor, but it could just as easily be someone who has no medical credentials whatsoever either in this country or in some place halfway around the world. So why would anyone even consider this practice? There is no hard data that even suggests it is being done in the United States. However, with telemedicine as a growing field, with reimbursement declining, and with nonradiologists getting more and more involved with imaging, ghosting could become more of a reality than ever before.

In May 2006, the ACR issued a statement on ghost reporting:

“It is unethical and likely fraudulent for a physician who has not personally interpreted the images obtained in a radiologic examination to sign a report or to take attribution of an interpretation of that examination rendered by another physician in a manner that causes the reader of a report to believe that the signing radiologist was the interpreter. This practice, known as ghost reporting, should be strictly prohibited.”

• What do you think the radiology community needs to do to make sure that this practice is not only discouraged, but prohibited? 
• Or, do you take the position that ghosting by radiologists or nonradiologists is nothing to be concerned about and that we need not bother with worrying? 

I would like to hear your thoughts.

NBC’s Today Show Airs Segment on Medical Imaging; Special Focus on Radiation Exposure, Accreditation and Self-Referral

On Thursday July 24, NBC’s Today Show — the most watched morning show on television — aired a segment with Chief Medical Editor Nancy Snyderman and co-host Meredith Vieira on medical imaging exams and radiation exposure.

The three-minute segment provided an overview of different imaging scans — mammograms, dental X-rays, full-body CT scans, bone density tests, and CT angiograms — and provided estimates for the amount of radiation received from each exam as they equated to radiation received from natural sources (e.g., one full-body CT scan = three years; one mammogram = three months). Dr. Snyderman echoed the ACR’s position against using body scans as a screening method, calling them a “fishing expedition.”

Most significantly, Dr. Snyderman highlighted the importance of patients taking charge of their health, and urged them to question their doctors when ordering scans, and ask:

• Why Do I Need This?
• Will It Improve My Health?
• Are There Safer Alternatives (i.e. no radiation)?
• Is This Facility Accredited by the American College of Radiology?
• Do You Have a Financial Interest?

ACR media and public relations efforts regarding quality imaging and the effect of financial incentives on imaging quality and cost are clearly having an effect. I urge you all to view the video below and to share this video with your colleagues (if you are having trouble viewing the video below, it can also be viewed on the NBC Web site, but please note that a short commercial will air before the segment begins).

What do you think the effect on imaging quality and cost might be if all patients asked these questions of their imaging providers?

I look forward to your thoughts.

ACR Efforts Head off Imaging Cuts, Improve Quality of Care

Due to ACR efforts and those of other members of the physician community, the Senate recently passed the Medicare Improvements for Patients and Providers Act of 2008 (H.R. 6331), which averted statutorily mandated physician payment cuts for 2008 and 2009 and actually provides payment increase for this year and next.

Due to efforts spearheaded by the ACR, there are NO imaging reimbursement cuts in this legislation. Again, the physician payment fix was accomplished without cuts to medical imaging to pay for it.

The legislation also calls for all providers of advanced diagnostic imaging services (MR, CT, PET, and nuclear medicine) to be accredited in order to receive payment for the technical component of those services and establishes a two-year voluntary demonstration program to test the use of physician-developed appropriateness criteria.

These quality standards will reduce the number of lesser trained providers performing suboptimal imaging, will focus lawmakers on the need for high quality imaging care provided by the best trained physicians, and will help facilitate uniform, quality care for seniors nationwide.

This legislation is a prime example of successful ACR advocacy, even in the face of a larger, more complicated issue, such as across-the-board cuts mandated by the sustainable growth rate (SGR) formula. It is an example of how the ACR serves the radiology community and helps ensure quality care for our patients.

This is why I pay my ACR dues. This is why the ACR is important to radiologists and why all radiologists should support the College.

I would ask that you make this point to our colleagues who choose not to support the ACR.

Also, please let me know how the ACR can better communicate the need for all radiologists and radiation oncologists to be members of the College.

I look forward to your thoughts.

Communication: When, Why and How

I was recently quoted in an article for the St. Louis Post-Dispatch on the practice of communicating radiology results directly to patients.

The radiology practice mentioned in the article delivers preliminary results to the patients while they are still at their office, through a method called “OnSite Results.” According to the imaging center’s founder it allows patients peace of mind when they would otherwise wait days or more for answers. Some may find this delivery method unusual; however, their business as well as their referring physician base is growing.

In my experience, this practice is not common. As physicians, we must be cautious in communicating results, so patients are ensured accurate information.

• What is your practice or department’s policy regarding communication of critical results?

• Would you consider delivering preliminary results to patients, and if so, what would you see as the benefits?

I look forward to your thoughts.

Tackling the Issues Through Leadership

At this year’s 85th Annual Meeting and Chapter Leadership Conference in Washington, D.C., I was honored by being named chair of the Board of Chancellors. This of course is a great privilege; however, I would like to extend some much deserved recognition to all the other leaders who were the recipients of high honors at the conference.

Eighty-five radiologists and medical physicists were honored for their individual contributions to the profession during the ACR Convocation and were awarded ACR Fellowship. Only 10 percent of ACR members achieve this distinction. Other honorees included three gold medalists and three honorary fellows. The Convocation is always a highlight of the conference, as we are reminded of the excellence that is consistently achieved by our peers.

We also got down to business at AMCLC, and discussed radiology’s future. As Dr. Pressman put it, we need to choose “distinction not extinction,” in reference to facing radiology’s ongoing challenges like self-referral, the role of teleradiology, and shrinking reimbursements.

These issues are almost too familiar to us — and it seems like a never-ending battle. In fact, these are the same types of issues our profession was facing 30 years ago, when I was a resident just beginning my career.

I’m looking forward to serving the next two years as your chair and to what together, we can accomplish. And although we have many difficult issues to face, we would not have gotten this far without the leadership of the ACR and our colleagues who have taken the lead in actively working to preserve our future. If you haven’t done so already, I urge you to take on an active role within the ACR. We need energetic, motivated individuals who are passionate about radiology to help carry out our ongoing efforts in areas such as economic and practice issues, financially motivated self-referral, and erosion of reimbursement.

What do you think are the biggest challenges facing the radiology profession and what do you think that the ACR and as importantly the radiologists in the field can do to address them?

MedPAC to Augment Primary Care Physician Reimbursement: Will That Attract More Doctors or Just Hurt Others?

The Medicare Payment Advisory Commission (MedPAC) has proposed an increased reimbursement to primary care physicians treating Medicare patients. The recommended increase, which is scheduled to reach Capitol Hill in June, is due primarily to recent data that suggest some Medicare beneficiaries may have difficulty finding a primary care doctor, and that fewer medical students are entering primary care.
                              
However, Sen. Max Baucus (D-Mont.) plans to submit Medicare legislation to the Senate in May which could include the proposal to increase primary care physician reimbursement in addition to another delay to the 10 percent cuts scheduled to hit all physicians July 1. The increase to primary care may come at the expense of other specialties.

If Congress follows MedPAC’s recommendation, the budget neutrality rules in Medicare’s budget will offset an increase to primary care doctors with a cut to others. The ACR is educating Congress that radiology cannot absorb another round of cuts to pay for increases to other specialties and offering more effective, targeted measures such as accreditation and the use of Appropriateness Criteria that can actually help eliminate unnecessary costs and raise quality of care.

Also, while adjusting reimbursements is one way to attract more students, it won’t diminish all of the perceived drawbacks to a career in medicine. Take Monday’s article in Forbes Magazine for example: Reasons Not to Become a Doctor. Citing increased practice costs versus lower reimbursement rates, cost of malpractice insurance, preauthorization, and student debt, it’s no surprise students are fearful of physician careers. See my post from last December about attracting more medical students to radiology for more on this topic.

Some hospitals are compensating by adding a new position to their workforce: the hospitalist. I read last Tuesday’s Wall Street Journal article on hospitalists with great interest, as it described the up-and-coming physician generation as seeking a work-life balance — and they’re getting it.

There are many issues here. Some will affect us imminently and others will be more impactful in the future. But I wonder, is there an alternate way of addressing this physician shortage while not pitting one physician specialty against another? What do you think is causing fewer Americans to become physicians?

I look forward to your thoughts.

New Technology Puts Care in Patient Hands

Keeping up with advancing information technology and trends in radiology and medicine in general is a full-time job. It seems as though every day new equipment debuts, scientific studies are released and software is redesigned. People are constantly working to advance the field which makes our jobs as physicians ever-changing.

This week, I’ve been particularly aware of technology as it pertains to patients. As reported in last Friday’s Daily News Scan, the Florida Hospital system is introducing kiosks to their radiology department in an effort to speed up the check-in process and will eventually allow patients to make payments on the machines.

Here’s another example: Patients of the Duke University Health System can now book appointments online — which may save phone calls, waiting room time and possibly frustration for hospital staff and patients.

And take Ohio State University Medical Center. They’re publishing consumer-focused data directly on their Web site to allow patients access to more information and ultimately more control over their health, according to the site. Everything from medical results statistics to patients’ opinions of the quality of service they received is published for the public to see.

Now, these examples are taken from large hospital systems which may or may not apply to your practice; however, I do wonder how powerful allowing patients to access specific information online would impact any radiology experience. On Monday, USA Today reported that doctor-rating Web sites — which are becoming increasing popular (though highly criticized) — have put doctors on the defensive, which I can’t say I believe this is good for medicine.

Recently, Dr. Thrall blogged about the AIM site, which offers estimates of the radiation received from specific imaging procedures. Many of you wrote in expressing your concern and ideas to alter this tool to be of use to patients and referring physicians.

• How has patient access to technology impacted your career; or, how do you see it changing your role as a physician in the future?
• How can we harness in all of the available information and make it relevant and available to our patients?

I understand the convenience and in some cases cost-effectiveness of allowing patients to take charge of their health. But where do we draw the line?

I look forward to your thoughts.